Objective:To investigate the management of cancer pain and the clinical practices of hospice care across 11 cities in Zhejiang Province.Methods:From May 22 to 29, 2023, the Zhejiang Provincial Health Commission conducted a survey to assess the current status of hospice care practitioners regarding cancer pain management, the practices employed by medical staff in managing cancer pain, and the understanding of medical personnel concerning self-controlled analgesia for cancer pain treatment in Zhejiang Province.Results:A total of 505 questionnaires were collected from 198 hospitals across 11 cities in the province.Among the medical staff in secondary and tertiary medical institutions, 85.71%(198 out of 231)participated in the management of cancer pain in patients.Oral analgesics emerged as the most commonly used treatment for pain outbreaks, accounting for 38.53%(89 out of 231)of cases.Additionally, 37.66%(87 out of 231)of medical personnel were involved in the development of self-controlled analgesia devices within their institutions.Conclusions:In the management of cancer pain within hospice care, it is essential to enhance the theoretical training of medical staff, ensure the availability of basic analgesic medications, and establish standardized management protocols for the entire process as promptly as possible.

Retinoblastoma (RB) is a malignant tumor that occurs mainly in children under 5 years of age.In recent years, the treatment of RB has been progressing, and the development of new methods and treatment strategies is of great significance to improve the survival rate and eye conservation rate of RB patients.However, in low- and middle-income countries, the number of patients with advanced RB is gradually increasing and the survival rate is declining due to poor economic conditions and limited medical resources.To this end, the Indian Council for Medical Research (ICMR) has drafted Consensus Document for Management of Retinoblastoma.This article interprets this document and provides personalized recommendations for the treatment and management of patients with intraocular and extraocular retinoblastoma in low- and middle-income countries based on the specific stage of unilateral/bilateral RB.

Retinoblastoma (RB) is a malignant tumor that occurs mainly in children under 5 years of age.In recent years, the treatment of RB has been progressing, and the development of new methods and treatment strategies is of great significance to improve the survival rate and eye conservation rate of RB patients.However, in low- and middle-income countries, the number of patients with advanced RB is gradually increasing and the survival rate is declining due to poor economic conditions and limited medical resources.To this end, the Indian Council for Medical Research (ICMR) has drafted Consensus Document for Management of Retinoblastoma.This article interprets this document and provides personalized recommendations for the treatment and management of patients with intraocular and extraocular retinoblastoma in low- and middle-income countries based on the specific stage of unilateral/bilateral RB.

Objective:To investigate the management of cancer pain and the clinical practices of hospice care across 11 cities in Zhejiang Province.Methods:From May 22 to 29, 2023, the Zhejiang Provincial Health Commission conducted a survey to assess the current status of hospice care practitioners regarding cancer pain management, the practices employed by medical staff in managing cancer pain, and the understanding of medical personnel concerning self-controlled analgesia for cancer pain treatment in Zhejiang Province.Results:A total of 505 questionnaires were collected from 198 hospitals across 11 cities in the province.Among the medical staff in secondary and tertiary medical institutions, 85.71%(198 out of 231)participated in the management of cancer pain in patients.Oral analgesics emerged as the most commonly used treatment for pain outbreaks, accounting for 38.53%(89 out of 231)of cases.Additionally, 37.66%(87 out of 231)of medical personnel were involved in the development of self-controlled analgesia devices within their institutions.Conclusions:In the management of cancer pain within hospice care, it is essential to enhance the theoretical training of medical staff, ensure the availability of basic analgesic medications, and establish standardized management protocols for the entire process as promptly as possible.

Objective:To investigate the safety and effectiveness of balloon occlusion and intra-sac thrombin injection in the endovascular repair of ruptured abdominal aortic aneurysm.Methods:From October 2019 to October 2022,the clinical data of 16 patients with rAAA treated with balloon occlusion technique and intra-sac thrombin injection combined with EVAR were retrospectively analyzed,including 13 males and 3 females,aged 42-85 years,with a median age of 70.5 years.The time of preoperative first aid(from hospital arrival to operation start),average operation time,stay in intensive care unit(ICU),average hospitalization time,success rate of surgical treatment,perioperative(30 d)mortality rate,incidence of complications,the maximum diameter and volume change of the aneurysm were observed and recorded.Results:Among the 16 patients with ruptured abdominal aortic aneurysm,the technical success rate was 100.0％(16/16).One patient died of multiple organ dysfunction 6 hours af-ter operation.The success rate of surgical treatment was 93.8％(15/16).The preoperative first aid time was(53.3±6.2)min,the average operation time was(89.9±17.1)min,the stay in the intensive care unit(ICU)was(1.7±0.8)d,and the average hospitalization time was(7.8±1.3)d.The intrao-perative balloon occlusion time was(32.4±4.1)min.The postoperative renal function of all the pa-tients had no significant deterioration compared with that preoperative.Abdominal compartment syndrome(ACS)occurred in 1 patient after operation,which improved after CT puncture and drainage.The medi-an follow-up time was 36 months.During the follow-up period,1 patient died of acute myocardial infarc-tion 2 years after operation,and the remaining 14 patients survived.Among the 14 follow-up patients,1 type Ⅱ endoleak occurred,and no other types of endoleak occurred.By the end of the follow-up,the maximum diameter of the aneurysm sac in 14 patients was significantly lower than that before operation[(44.6±8.0)mm vs.(66.0±15.5)mm,P＜0.001],and in 12 patients with CTA,the volume of the aneurysm sac was significantly shrunk than that before operation[(311.7±170.3)mm3 vs.(168.6±68.1)mm3,P＜0.05].Conclusion:Balloon occlusion during endovascular repair is safe and effective in the treatment of ruptured abdominal aortic aneurysm;intraoperative thrombin injection of the aneurysm sac can significantly reduce the incidence of intraoperative and postoperative abdominal compartment syndrome and endoleak and,to a certain extent,improve the success rate of treatment.

Objective:To investigate the clinical value of digital technology in repair of soft tissue defect in hand by anterior tibial artery perforator flap.Methods:From January 2015 to February 2021, 9 patients with soft tissue defects in hand were repaired with anterior tibial artery perforator flap assisted by digital technology in flap design, including 6 males and 3 females aged from 19 to 63 years with a mean age of 33 years. The size of defects varied from 2.0 cm×1.5 cm to 4.0 cm×3.0 cm, with exposed bones or tendons. Preoperative CTA scan of lower limb was performed and three-dimensional image was reconstructed with Mimics 20.0. The anterior tibial artery perforator flap was designed according to the shape and size of the defect, then the resection of flap was digitally simulated. The flap based on the digital design was harvested and the defect was repaired in the operation. The size of flap was 2.5 cm×2.0 cm~4.5 cm×3.5 cm. Outpatient clinic follow-up was performed to evaluate the survival of flaps. Disability of Arm, Shoulder and Hand(DASH) was used for function evaluation.Results:All flaps were harvested successfully and all donor sites were closed directly. After surgery, 8 flaps survived completely. One flap developed venous occlusion that showed partial necrosis of the flap, and it was rescued after exploration and re-anastomosis. The follow-up period ranged from 6 to 21 months, with an average of 13 months. The DASH scores of the affected limb were 2 to 15 points at the last follow-up, with an average of 6.4 points. Mild scar hyperplasia occurred at donor site in 1 case without sensory abnormality.Conclusion:The digital technology is able to accurately locate the perforators by allowing an individualised design of the anterior tibial artery perforator flap. The flap is suitable for repair of small and medium-sized soft tissue defect in hand, and the digital technology has certain value in clinical application.

Air pollution is the over emission of harmful materials into atmosphere,causing damage to human beings and other organisms.Some researches indicate that air pollution can damage ocular surface,change the tear's ingredients,and cause some symptoms,such as red eyes,lacrimation,foreign body sensation and so on.It can also change the components of the tear and damage the epithelial cells of the eyes.The mechanisms including the direct effects of the pollutant,the secondary changes of the tear,the inflammation and the oxidative stress response.As the growing problems of air pollution,its influence on ocular surface has been attracting more and more attentions.How to prevent the damage caused by air pollution is the question that ophthalmologists should think about in the future.In this paper,we focus on the sources and ingredients of air pollution,the changes and the pathogenesis of ocular surface caused by air pollution and the summary of the studies of air pollution on the ocular surface in the past few years.Studying the influence of air pollution on ocular surface significantly contributes to the theoretical research and clinical prevention.

Objective To investigate the histopathological and ultrastructural changes of corneal epithelium induced by erlotinib in mice.Methods Totally 30 6-8 weeks old male BALB/c mice were divided into three groups:Control group (n =12),experimental group (n =12),another 6 mice did nothing as the blank control.Experimental group used erlotinib eye drops and control group used PBS in both eyes,four times per day.At 1 day,7 days and 14 days after the intervention,corneal fluorescence staining (FL) was observed by slit lamp and graded.On the fourteenth day after the intervention,the eye balls of mice were taken,and the histopathological and ultrastructural changes of corneal epithelium and epithelial cells were observed by optical microscope and electron microscope,respectively.And protein of cornea was measured by Western Blot.Results Before the intervention,there was no significant difference in FL scores between the experimental group and control group (P ＞ 0.05).At 1 day,7 days and 14 days,FL score of experimental group was significantly higher than the groups of non-intervention,the difference was statistically significant (all P ＜ 0.05).While FL score of control group was not statistically significant before and after intervention (all P ＞ 0.05);Compared between two groups,there were statistical differences at 7 days,14 days in FL score (all P ＜ 0.05).In the experimental group,the histopathological changes of murine corneal epithelial cells had disorderly arrangement,increased layers of cells,and the inflammatory cells.Under electron microscope,the morphology of corneal epithelial surface cells was irregular and partially detached.The number of microvilli,desmosomes and hemidesmosomes were significantly decreased when compared to the control group.The expression of p-EGFR in experimental group was significantly less than that in control group,the difference was statistically significant (P ＜ 0.05).Conclusion Erlotinib can damage the tissue structure of corneal epithelium and ultrastructure of corneal epithelial cells in mice.And the mechanism is probably that erlotinib influence the corneal epithelium by inhibiting the EGFR activation.

Based on large sample of clinical epidemiology survey,we discussed the etiology and pathogenesis of type-2 diabetes.On the basis of Internal Classic ofHuang Di,and discussions of both ancient and modern doctors,we believed that:type 2 diabetes is just like Jueyin disease of Treatise on Febrile Disease,characterizing by adverse-rising of Qi,cold mingling with heat and deficiency mingling with access.The diseased location is spleen,and closely related with liver and lung.The pathogenesis is the failure transportation and transformation of spleen,floating of deficient five visceral essence,and turbid dampness flowing down to form yin fire syndrome.The reason for failure transportation and transformation of spleen includes depression of lung,adverse flow of liver-qi,dampness accumulation in the middle and deficiency of kidney Qi.